Provider Demographics
NPI:1356710347
Name:MERRELL, LAUREN (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:DEISENROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:3583 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1820
Mailing Address - Country:US
Mailing Address - Phone:503-218-3866
Mailing Address - Fax:503-343-6158
Practice Address - Street 1:3583 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1820
Practice Address - Country:US
Practice Address - Phone:503-218-3866
Practice Address - Fax:503-343-6158
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606691NP-PP363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health